Blue digit syndrome: treatment with percutaneous transluminal angioplasty

Ten patients with classical blue digit syndrome were treated with percutaneous transluminal angioplasty (PTA). None experienced embolization. Nine were clinically improved; in eight, microembolization did not recur during follow-up of 7-86 months (mean, 28 months). Three clinical and three angiographic features were common to these eight patients: (a) few clinical episodes of microembolization; (b) no episodes of macroembolization; (c) no livedo reticularis in the affected extremity, and no symptoms of systemic cholesterol embolization; (d) focal, high-grade (greater than 90%) stenoses that were hemodynamically significant; (e) no diffuse atheromas in the aorta; (f) patent tibial runoff arteries. Affected patients with these clinical and angiographic characteristics make up a subgroup, previously unrecognized, to the authors' knowledge, in whom PTA followed by antiplatelet therapy should be the initial treatment of choice. The blue digit syndrome in these patients was probably due to microemboli composed of fibrinoplatelet aggregates rather than cholesterol debris.